Autologous Tooth Dentin Graft: A Retrospective Study in Humans

Background and Objectives: The aim of this study is to evaluate the efficacy of an autologous dentin graft, via extracted teeth that are processed into bacteria-free particulate dentin in a Smart dentin grinder and then grafted immediately into alveolus post extraction or into bone deficiencies. Materials and Methods: Ten healthy, partially edentulous patients with some teeth in the mandible were recruited in the study. After their own teeth were grinded, particulate teeth were placed in empty sockets and bone defects after teeth extractions. Furthermore, after three, six, 12 and 24 months, core samples using a 3 mm trephine were obtained. Results: At three months, the particles of grinded tooth were immersed inside a new connective tissue with a small new bone formation (16.3 ± 1.98). At six months, we observed small particles of dentin integrated in new immature bone, without inflammation in the soft tissue (41.1 ± 0.76). At twelve months, we observed a high amount of bone formation surrounding tooth particles (54.5 ± 0.24), and at twenty-four months, new bone, a big structure of bone, was observed with dentin particles (59.4 ± 1.23), statistically different when compared it with at three months. Conclusions: A particulate dentin graft should be considered as an alternative material for sockets’ preservation, split technique, and also for sinus lifting. One of the special characteristics after 24 months of evaluation was the high resorption rate and bone replacement without inflammation. This material could be considered as an acceptable biomaterial for different bone defects due to its osteoinductive and osteoconductive properties

Piezoelectric driven mandibular ridge split technique with immediate implant placement: A case report

Narrow dentoalveolar ridges pose a major challenge for the successful placement of endosseous implants. This case report focuses on a Piezoelectric driven mandibular Ridge Split technique without vertical osteotomy for an immediate implant placement in a narrow alveolar ridge measuring 3.0mm. Following anaesthesia, a mucoperiosteal flap was elevated after giving a mid-crestal incision distal to 35 along the entire edentulous ridge. Then, with the help of a micro-saw and horizontal spreaders, an osteotomy site of required diameter was achieved. Finally twist drills were used and implants were placed in the expanded site. Clinically, healing was uneventful with no step defect in the expanded buccal bone and the final occlusion obtained was satisfactory. The Piezo-electric driven Ridge Split technique promises to be a minimally invasive option for horizontal augmentation of narrow alveolar ridges- predictability within a short interval of time and with minimal risk of fracture.

Evaluation of the Split-crest Technique with SimultaneousImplant Placement in Atrophic Edentulous Maxillary and Mandibular Bone: A 5-Year Follow-up Study

Aim: To evaluate the behavior of the alveolar ridge split technique in a series of surgical cases. Materials and Methods: One hundred and fifty implants were included in this study for a total of 60 patients. The surgeries consisted of a mid-crestal incision and subsequent bone management with a piezoelectric system. The implants were placed after the alveolar bone was expanded by about 3mm and present bony defects were filled by a mixture of 50% autogenous bone and a xenograft (Bio-Oss®). Bone fracture of the buccal alveolar plate occurred in 8 cases, and those were stabilized with osteosynthesis screws. Implants were simultaneously placed in 140 cases, out of them 4 failures occurred due to membrane exposition. Results: The osseointegration success was estimated to be 97.5%. Conclusion: This study concluded that the bone splitting/expansion seem to be a reliable, predictable, relatively noninvasive technique with limited intraoperative complications. Clinical significance: The study revealed that the alveolar ridge split can be used as an effective technique for atrophic edentulous maxillary and mandibular bone

A Unique Way of Removing Mandibular Third Molars - Implosion Technique

The average time consumed for disimpaction of mandibular third molar using rotatory instruments was approximately 17 mins and 23 mins while using a piezotome. The authors introduce a new technique of disimpaction of mandibular third molar with the least amount of bone removal ever achieved during mandibular third molar removal. This technique can be readily included in routine clinical practice and can be performed by using routine rotary instruments. This technique was successfully accomplished in 10 individuals with the least amount of discomfort and post-operative complications reported from day 1 to day 14. The procedure was evaluated based on time of the procedure, pain score, bleeding, nerve injury, trismus, swelling & dry socket. Third molar removal has been the most frequently performed oral surgical procedure in the modern world of dentistry.1 Although, mandibular third molar is the most commonly performed procedure, it demands skill, technique and experience. Several techniques have been implied for disimpaction of mandibular third molar, but every method involves either considerable amount of bone removal or splitting the bone. Bone manipulation is done by using a rotary instruments or chisel and mallet. The most popular techniques are buccal bone guttering, distal bone removal, lingual bone split technique and lingual bone guttering.2 According to the traditional classifications of impacted mandibular third molar (Pell & Gregory and Winter’s classification), the minimum amount of bucco-distal bone removed during disimpaction of mesioangularly positioned class I A impacted mandibular third molar using rotary instruments and conventional techniques can be calculated as 157.5 mm2 (volume of a rectangle = L X W X H; where L = 15 mm, W = 1.5 mm [width of the bur] and H = 7 mm). The mandibular third molar requiring osteotomy and tooth section have the highest risk of complications3. Surgical time had significantly increased in cases which required osteotomy and tooth section. Post-operative swelling and pain has been recorded as significant complications after using rotary instruments via buccal approach followed by use of chisel & mallet and least in lingual split approach. On the contrary, post-operative nerve injury and trismus were significantly high in lingual split technique. Dry socket was more in patients of bur technique.2

Interlayer Dural Split Technique for Chiari I Malformation Treatment in Adult -- Technical Note

Objective: To present an alternative surgical technique in treating cases of Chiari I Malformation with mild-to-moderate syringomyelia after decompressive suboccipital craniectomy: incising only the outer layer of the dura mater, then dissecting it from the inner layer without opening the latter. Methods and Results: We utilized this technique in a short series of three cases who were admitted in our department for mild symptoms such as intermittent headache and dissociated sensory loss in the upper limbs, caused by a Chiari Malformation Type I. The patients were placed in the sitting position. We performed a reduced median suboccipital craniectomy and resection of the posterior arch of C1 adapted to the level of tonsil descent, from a limited superior half to a complete resection. Afterwards, we incised the outer dural layer, while sparing the inner one. Using a fine dissector, we then split apart the outer and inner layers to the margin of the craniectomy. Through the transparency of the inner layer and the arachnoid, the cerebellum and the medulla were visible and pulsating. An autologous fascia duraplasty was then performed. The postoperative course was favorable in all cases, patients being discharged without any deficits and with complete symptom resolution. Conclusions: Interlayer dural split technique can be used effectively in treating symptomatic cases of type I Chiari malformation in adults, with mild-to-moderate syringomyelia. It is less invasive than opening the dura and possibly more effective than decompressive craniectomy and C1 laminectomy alone. This technique must be validated in a larger case-control series.